Transverse Rectus Abdominus Myocutaneous (TRAM) Flap

In transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction, Mass General plastic surgeons use tissue from the lower abdomen to create a new breast after mastectomy.

About This Procedure

TRAM Flap Breast Reconstruction

If you have a mastectomy to treat or prevent cancer, breast reconstruction can surgically recreate a natural-looking breast. One option for breast reconstruction is a transverse rectus abdominus myocutaneous (TRAM) flap procedure.

In a TRAM flap, the surgeon first removes muscle, fat and skin from the lower abdomen. (If you lack sufficient abdominal tissue, areas such as the back, buttocks or thigh may be used instead.) The tissue, or "flap," is then transferred to the mastectomy area, where it is shaped to form a new breast.

A TRAM flap can be performed at the time of your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction) for one or both breasts. This procedure produces: a breast that feels natural and a slimmer, flatter abdomen (as is seen in a tummy tuck).

Please note: A TRAM flap leaves a scar that extends along the lower abdomen, from one hip to the other. As a result, the recovery period may be longer than with breast construction with implants or tissue expanders.

Two Types of TRAM Flap

The two types of TRAM flap breast reconstruction are the pedicle flap and free flap.

  • Pedicle flap: The blood vessels of the transferred tissue remain attached as the flap is tunneled under the skin of the upper abdomen into the breast pocket
  • Free flap: The tissue is removed from its blood supply and brought up to the breast pocket, where blood flow is restored by reconnecting the artery and vein using microsurgery. The flap is connected to the blood vessels under the arm, or under the breast bone.

Are You a Candidate for TRAM Flap Breast Reconstruction?

You may be a good candidate for TRAM flap reconstruction if you:

  • Prefer to reconstruct one or both breasts using your own tissue
  • Have sufficient tissues in your lower abdomen to create one or both breasts
  • Have never had surgery on your abdomen
  • Are not a candidate for implant reconstruction
  • Have had radiation administered to your chest wall
  • Have had failed reconstruction using a breast implant

You may not be a good candidate for TRAM flap reconstruction if you:

  • Lack sufficient lower abdominal tissue to create acceptable breast volume
  • Have had abdominal surgery (e.g. an abdominoplasty)
  • Smoke (or quit smoking only recently)
  • Have diabetes
  • Are obese
  • Have an overly large abdominal pannus (hanging flap of tissue)
  • Cannot tolerate prolonged general anesthesia
  • Do not want a lower abdominal scar

Other Flap Options

Depending on your particular situation, other flap options to create the new breast may include:

The TUG flap and SGAP/IGAP flaps are generally used with patients who lack enough abdominal tissue for the DIEP or SIEA flap.

Breast Reconstruction at Mass General

Our plastic surgeons have extensive experience in all types of breast reconstructive techniques, including the newest and most innovative procedures. When appropriate, we combine techniques, using flaps, implants and nipple tattooing to achieve the most natural-looking outcome.

All forms of breast reconstruction after mastectomy have inherent risks, which will be fully discussed during your consultation.


Contact Us

Division of Plastic and Reconstructive Surgery

Wang Ambulatory Care Center 435

55 Fruit Street Boston, MA 02114, USA

We are also located at:

Mass General/North Shore Center for Outpatient Care
102 Endicott Street
Danvers, MA 01923

The Mass General Division of Plastic and Reconstructive Surgery is located in the Wang Ambulatory Care Center at 15 Parkman St. Parking is available in the Parkman St. and nearby Fruit St. and Yawkey Center garages. Please note that some GPS systems do not recognize the 15 Parkman St. address. If you use a GPS system to drive to Mass General, enter Blossom St. as your destination, and then turn onto Parkman directly from Blossom.

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